MACULAR CHANGES IN PSEUDOTUMOR CEREBRI BEFORE AND AFTER OPTIC-NERVE SHEATH FENESTRATION

Purposes: Macular abnormalities such as chorioretinal striae, pigmenta ry disturbances, exudates, and subretinal hemorrhage or scar can occur in patients with pseudotumor cerebri. The purpose of this study is to determine the potential resolution of the macular abnormalities after optic nerve sheath fenestration, as well as the visual significance o f these changes. Methods: The authors retrospectively compared the pre operative and postoperative examinations of seven patients with pseudo tumor cerebri-associated macular changes who underwent unilateral opti c nerve sheath fenestration. Results: Preoperatively, visual acuity wa s worse than 20/25 in two patients with macular exudates and in one wi th a subretinal scar. Chorioretinal striae and pigment mottling did no t appear to decrease visual acuity. With a mean postoperative follow-u p of 14 months, the patients with exudates had improvement in visual a cuity and clearing of the exudates, unlike the patient with the subret inal scar. Chorioretinal striae, pigment mottling, and the subretinal scar did not resolve with surgery. Conclusions: This study suggests th at chorioretinal striae and pigment mottling in the setting of pseudot umor cerebri, unlike exudates and subretinal scars, do not have a sign ificant effect on visual acuity. After optic nerve sheath fenestration , only macular exudates decreased. Therefore, the persistence of stria e, pigment mottling, and macular scars, in the face of resolved papill edema and improved visual fields, does not indicate failure of the opt ic nerve sheath fenestration.